急性髓性白血病患者二次挽救治疗后的结局。

Outcome of patients with acute myelogenous leukemia after second salvage therapy.

作者信息

Giles Francis, O'Brien Susan, Cortes Jorge, Verstovsek Srdan, Bueso-Ramos Carlos, Shan Jianqin, Pierce Sherry, Garcia-Manero Guillermo, Keating Michael, Kantarjian Hagop

机构信息

Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, PO Box 301402, Houston, TX 77230-1402, USA.

出版信息

Cancer. 2005 Aug 1;104(3):547-54. doi: 10.1002/cncr.21187.

DOI:10.1002/cncr.21187

PMID:15973664

Abstract

BACKGROUND

Although the prognosis is poor for patients with acute myelogenous leukemia (AML) who have disease recurrence after frontline therapy, this is a general reflection of first salvage therapies. The outcome of patients undergoing second salvage therapy in relation to complete response (CR) rates and survival has not been documented. The authors analyzed the outcome of patients with AML undergoing second salvage therapy, and identified prognostic factors associated with response and survival.

METHODS

The records of 594 patients with AML undergoing second salvage therapy from 1980 until 2004 were reviewed. The patient median age was 50 years. Salvage therapy included allogeneic stem cell transplantation (SCT) in 74 patients, standard-dose cytosine arabinoside (ara-C) combinations in 30 patients, high-dose ara-C combinations in 171 patients, non-ara-C combinations in 73 patients, and Phase I-II single agents in 246 patients.

RESULTS

Overall, 76 patients (13%) achieved CR. The median CR duration was 7 months. The median survival was 1.5 months, and the 1-year survival rate was 8%. A multivariate analysis of prognostic factors for CR identified the following 6 independent adverse factors: first CR duration < 6 months; second CR duration < 6 months; salvage therapy not including allogeneic SCT; non-inversion 16 AML; platelet counts < 50 x 10(9)/L, and leukocytosis > 50 x 10(9)/L. Patients were divided into low-risk (1-2 adverse factors; 8%), intermediate 1 (3 factors; 20%), intermediate 2 (4 factors; 38%), and high-risk groups (5-6 factors; 33%) with respective CR rates of 54%, 26%, 8%, and 0%. The respective 1-year survival rates were 36%, 21%, 6%, and 1%. A multivariate analysis for survival identified the following 7 independent adverse factors: first CR duration < 12 months; second CR duration < 6 months; bilirubin level > or = 1 mg/dL; albumin level < 3 g/dL; age > 60 years; bone marrow blasts > or = 50%; and year of therapy before 1991. Patients were divided into low-risk (0-2 adverse factors; 39%), intermediate (3 factors; 27%), and high-risk groups (> or = 4 factors; 34%) with estimated 1-year survival rates of 22%, 6%, and 0%, respectively. The respective CR rates were 26%, 8%, and 2%.

CONCLUSIONS

The current analysis established the outcome and prognostic factors associated with second salvage therapy in AML. It also proposed risk models and groups that could be used for comparison of results of present and future investigational strategies.

摘要

背景

尽管一线治疗后疾病复发的急性髓系白血病（AML）患者预后较差，但这是首次挽救治疗的总体反映。关于接受二次挽救治疗的患者的完全缓解（CR）率和生存率的结果尚无文献记载。作者分析了接受二次挽救治疗的AML患者的结果，并确定了与缓解和生存相关的预后因素。

方法

回顾了1980年至2004年期间594例接受二次挽救治疗的AML患者的记录。患者的中位年龄为50岁。挽救治疗包括74例患者接受异基因干细胞移植（SCT），30例患者接受标准剂量阿糖胞苷（ara-C）联合治疗，171例患者接受大剂量ara-C联合治疗，73例患者接受非ara-C联合治疗，246例患者接受I-II期单药治疗。

结果

总体而言，76例患者（13%）达到CR。CR的中位持续时间为7个月。中位生存期为1.5个月，1年生存率为8%。对CR的预后因素进行多变量分析，确定了以下6个独立的不良因素：首次CR持续时间<6个月；第二次CR持续时间<6个月；挽救治疗不包括异基因SCT；16号染色体不倒位的AML；血小板计数<50×10⁹/L，以及白细胞增多>50×10⁹/L。患者被分为低风险组（1-2个不良因素；8%）、中危1组（3个因素；20%）、中危2组（4个因素；38%）和高风险组（5-6个因素；33%），各自的CR率分别为54%、26%、8%和0%。各自的1年生存率分别为36%、21%、6%和1%。对生存的多变量分析确定了以下7个独立的不良因素：首次CR持续时间<12个月；第二次CR持续时间<6个月；胆红素水平≥1mg/dL；白蛋白水平<3g/dL；年龄>60岁；骨髓原始细胞≥50%；以及1991年之前的治疗年份。患者被分为低风险组（0-2个不良因素；39%）、中危组（3个因素；27%）和高风险组（≥4个因素；34%），估计1年生存率分别为22%、6%和0%。各自的CR率分别为26%、8%和2%。